<!-- 物件リクエストお問い合わせ入力画面 -->
	<!-- InstanceEndEditable -->
	<div id="main">
		<!-- InstanceBeginEditable name="main" -->
		<!-- requestBlock -->
		<div id="requestBlock">
			<h1 style="text-align: left;">{$contentsTitle}</h1>
			<p class="bar"><img src="/images/inquiry/hp/form/img_req_bar_01.jpg" alt="お客様情報の入力" width="710" height="32" /></p>
			<p class="lead">アパマンショップ物件リクエスト登録をご利用いただきありがとうございます。 ご希望の連絡方法にて速やかに誠心誠意ご対応させていただきます。「<a href="http://www.fcapamanshop.com/privacy.html" target="_blank">個人情報の取り扱いについて</a>」をご確認・同意の上、お問い合わせください。</p>

			<div id="conditionData">
				<!-- selectDetailBlock06 -->
				<div class="selectDetailBlock06">
					<div class="section">
						<p class="title">検索条件</p>
					</div>
					<!-- innerBlock01 -->
					<div class="innerBlock01" style="text-align: left;">
						<!-- innerBlock02 -->
						<div class="innerBlock02">
							<table>
								<tbody><tr>
									<th>地域・沿線</th>
									<td>{$condition1}</td>
								</tr>
								<tr>
									<th>基本条件</th>
									<td>{$condition2}</td>
								</tr>
								<tr>
									<th>こだわり条件</th>
									<td>{$condition3}</td>
								</tr>
							</tbody></table>
						</div>
						<!-- /innerBlock02 -->
					</div>
					<!-- /innerBlock01 -->
				</div>
				<!-- /selectDetailBlock06 -->
			</div>
			<!-- inqHouseForm -->
			<table id="inqHouseForm" style="text-align: left;">
				<tr>
					<th>契約形態&nbsp;<span class="attTxt">[必須]</span></th>
					<td>
						<input type="radio" name="keiyakutype" id="keiyakutype" value="1" class="required" {if $keiyakutype == 1 }checked{/if} {if $keiyakutypeFix == 2 }disabled{/if} />
						<label for="keiyakutype1">法人</label>
						<input type="radio" name="keiyakutype" id="keiyakutype" value="2" class="required" {if $keiyakutype == 2 }checked{/if} {if $keiyakutypeFix == 1 }disabled{/if} />
						<label for="keiyakutype2">個人</label>&nbsp;
						<p class="errTxt" htmlfor="keiyakutype" generated="true" />
					</td>
				</tr>


				<tr>
					<th>会社名&nbsp;<span class="attTxt">[必須]</span></th>
					<td><p><input name="UserComName" id="UserComName" value="{$UserComName}" type="text" class="inputBox01 required zenkaku" maxlength="20" size="30" style="IME-MODE: active" /></p>
						<p class="errTxt" htmlfor="UserComName" generated="true" />
					</td>
				</tr>
				<tr>
					<th>お名前&nbsp;<span class="attTxt">[必須]</span></th>
					<td><p>（姓）<input name="NameSei" id="NameSei" value="{$NameSei}" type="text" class="inputBox01 required zenkaku" maxlength="10" style="IME-MODE: active" />
							（名）<input name="NameMei" id="NameMei" value="{$NameMei}" type="text" class="inputBox01 required zenkaku" size="20" maxlength="10" style="IME-MODE: active" class="inputBox01" /></p>
						<p class="errTxt" htmlfor="NameSei" generated="true" />
						<p class="errTxt" htmlfor="NameMei" generated="true" />
					</td>
				</tr>
				<tr>
					<th>メールアドレス&nbsp;<span class="attTxt">[必須]</span></th>
					<td>
						<input name="Mail1" value="{$Mail}" id="Mail1"class="required  email" type="text" style="ime-mode:inactive" size="30" maxlength="50" /><span class="css10">（半角英数字）</span>
						<p>確認の為、再入力</p>
						<input name="Mail2" value="{$Mail}" id="Mail2" class="required  email equalTo" type="text" size="30" maxlength="50" style="IME-MODE: inactive" /><span class="css10">（半角英数字）</span>
						<p class="attTxt02">※携帯電話の場合は「apamanshop.co.jp」を受け取る設定にしてください。</p>
						<p class="errTxt" htmlfor="mail" generated="true" ></p>
					</td>
				</tr>
				<tr>
					<th>電話&nbsp;<span class="attTxt">[必須]</span></th>
					<td>
							<input name="Tel1" value="{$Tel1}" type="text" id="Tel1"class="required number" style="ime-mode:inactive" size="10" maxlength="4" />
							－
							<input name="Tel2" value="{$Tel2}" type="text" id="Tel2"class="required number" style="ime-mode:inactive" size="10" maxlength="4" />
							－
							<input name="Tel3" value="{$Tel3}" type="text" id="Tel3"class="required number" style="ime-mode:inactive" size="10" maxlength="4" />
							<span>（半角数字）</span>
						<br/><br/>
							<p>ご希望時間帯
							<select name="NeedTimeKbn" id="NeedTimeKbn" value="{$NeedTimeKbn}">
								<option value="0" {if $NeedTimeKbn == "" || $NeedTimeKbn == "0"} selected="selected" {/if}>希望なし</option>
								<option value="1" {if $NeedTimeKbn == "1"} selected="selected" {/if}>10時以前</option>
								<option value="2" {if $NeedTimeKbn == "2"} selected="selected" {/if}>10時～12時</option>
								<option value="3" {if $NeedTimeKbn == "3"} selected="selected" {/if}>12時～14時</option>
								<option value="4" {if $NeedTimeKbn == "4"} selected="selected" {/if}>14時～16時</option>
								<option value="5" {if $NeedTimeKbn == "5"} selected="selected" {/if}>16時～18時</option>
								<option value="6" {if $NeedTimeKbn == "6"} selected="selected" {/if}>18時以降</option>
							</select></p>
							<p class="errTxt" htmlfor="tel" generated="true" ></p>
					</td>
				</tr>
				<tr>
					<th>FAX&nbsp;</th>
					<td>
						<input name="Fax1" value="{$Fax1}" id="Fax1" class="number" type="text" size="10" maxlength="4" style="IME-MODE: inactive" />
						－
						<input name="Fax2" value="{$Fax2}" type="text" size="10" id="Fax2"class="number" maxlength="4" style="IME-MODE: inactive" />
						－
						<input name="Fax3" value="{$Fax3}" type="text" size="10" id="Fax3"class="number" maxlength="4" style="IME-MODE: inactive" />
						<span class="css10">（半角数字）</span>
						<p class="errTxt" htmlfor="fax" generated="true" ></p>
					 </td>
				</tr>
				<tr>
					<th>駐車場台数&nbsp;</th>
					<td>
						<input name="chushajoDaisu" value="{$chushajoDaisu}" id="chushajoDaisu" class="number" type="text" size="3" maxlength="3" style="IME-MODE: inactive" />台
						<p class="errTxt" htmlfor="chushajoDaisu" generated="true" ></p>
					 </td>
				</tr>
				<tr>
					<th>入居希望日&nbsp;<span class="attTxt">[必須]</span></th>
					<td>
						<p>
						<select name="nyukyoM" id="nyukyoM" value="{$nyukyoM}">
							<option value="0"  {if $nyukyoM == "" || $nyukyoM == "0"} selected="selected" {/if}>指定なし</option>
							<option value="1"  {if $nyukyoM == "1"}  selected="selected" {/if}>1</option>
							<option value="2"  {if $nyukyoM == "2"}  selected="selected" {/if}>2</option>
							<option value="3"  {if $nyukyoM == "3"}  selected="selected" {/if}>3</option>
							<option value="4"  {if $nyukyoM == "4"}  selected="selected" {/if}>4</option>
							<option value="5"  {if $nyukyoM == "5"}  selected="selected" {/if}>5</option>
							<option value="6"  {if $nyukyoM == "6"}  selected="selected" {/if}>6</option>
							<option value="7"  {if $nyukyoM == "7"}  selected="selected" {/if}>7</option>
							<option value="8"  {if $nyukyoM == "8"}  selected="selected" {/if}>8</option>
							<option value="9"  {if $nyukyoM == "9"}  selected="selected" {/if}>9</option>
							<option value="10" {if $nyukyoM == "10"} selected="selected" {/if}>10</option>
							<option value="11" {if $nyukyoM == "11"} selected="selected" {/if}>11</option>
							<option value="12" {if $nyukyoM == "12"} selected="selected" {/if}>12</option>
						</select>月
						<select name="nyukyoD" id="nyukyoD" value="{$nyukyoD}">
							<option value="0"  {if $nyukyoD == "" || $nyukyoD == "0"} selected="selected" {/if}>指定なし</option>
							<option value="1"  {if $nyukyoD == "1"}  selected="selected" {/if}>1</option>
							<option value="2"  {if $nyukyoD == "2"}  selected="selected" {/if}>2</option>
							<option value="3"  {if $nyukyoD == "3"}  selected="selected" {/if}>3</option>
							<option value="4"  {if $nyukyoD == "4"}  selected="selected" {/if}>4</option>
							<option value="5"  {if $nyukyoD == "5"}  selected="selected" {/if}>5</option>
							<option value="6"  {if $nyukyoD == "6"}  selected="selected" {/if}>6</option>
							<option value="7"  {if $nyukyoD == "7"}  selected="selected" {/if}>7</option>
							<option value="8"  {if $nyukyoD == "8"}  selected="selected" {/if}>8</option>
							<option value="9"  {if $nyukyoD == "9"}  selected="selected" {/if}>9</option>
							<option value="10" {if $nyukyoD == "10"} selected="selected" {/if}>10</option>
							<option value="11" {if $nyukyoD == "11"} selected="selected" {/if}>11</option>
							<option value="12" {if $nyukyoD == "12"} selected="selected" {/if}>12</option>
							<option value="13" {if $nyukyoD == "13"} selected="selected" {/if}>13</option>
							<option value="14" {if $nyukyoD == "14"} selected="selected" {/if}>14</option>
							<option value="15" {if $nyukyoD == "15"} selected="selected" {/if}>15</option>
							<option value="16" {if $nyukyoD == "16"} selected="selected" {/if}>16</option>
							<option value="17" {if $nyukyoD == "17"} selected="selected" {/if}>17</option>
							<option value="18" {if $nyukyoD == "18"} selected="selected" {/if}>18</option>
							<option value="19" {if $nyukyoD == "19"} selected="selected" {/if}>19</option>
							<option value="20" {if $nyukyoD == "20"} selected="selected" {/if}>20</option>
							<option value="21" {if $nyukyoD == "21"} selected="selected" {/if}>21</option>
							<option value="22" {if $nyukyoD == "22"} selected="selected" {/if}>22</option>
							<option value="23" {if $nyukyoD == "23"} selected="selected" {/if}>23</option>
							<option value="24" {if $nyukyoD == "24"} selected="selected" {/if}>24</option>
							<option value="25" {if $nyukyoD == "25"} selected="selected" {/if}>25</option>
							<option value="26" {if $nyukyoD == "26"} selected="selected" {/if}>26</option>
							<option value="27" {if $nyukyoD == "27"} selected="selected" {/if}>27</option>
							<option value="28" {if $nyukyoD == "28"} selected="selected" {/if}>28</option>
							<option value="29" {if $nyukyoD == "29"} selected="selected" {/if}>29</option>
							<option value="30" {if $nyukyoD == "30"} selected="selected" {/if}>30</option>
							<option value="31" {if $nyukyoD == "31"} selected="selected" {/if}>31</option>
						</select>日

						</p>
						<p class="inqTxt">
						入居希望日が未定の場合はいかにご入力下さい。<br/>
						⇒記入例：●月下旬頃まで／良い物件があり次第　等<span>(50文字以内)</span></p>
						<input type="text" name="nyukyoBiko" id="nyukyoBiko" maxlength="50" class="maxlength" style="IME-MODE: active; width:500px;" value="{$nyukyoBiko}" />
						<p class="errTxt" htmlfor="nyukyo" generated="true" />
						</p>
					</td>
				</tr>
				<tr>
					<th>内見希望日&nbsp;</th>
					<td>
						<p>
						<select name="naikenM" id="naikenM" value="{$naikenM}">
							<option value="0"  {if $naikenM == "" || $naikenM == "0"} selected="selected" {/if}>指定なし</option>
							<option value="1"  {if $naikenM == "1"}  selected="selected" {/if}>1</option>
							<option value="2"  {if $naikenM == "2"}  selected="selected" {/if}>2</option>
							<option value="3"  {if $naikenM == "3"}  selected="selected" {/if}>3</option>
							<option value="4"  {if $naikenM == "4"}  selected="selected" {/if}>4</option>
							<option value="5"  {if $naikenM == "5"}  selected="selected" {/if}>5</option>
							<option value="6"  {if $naikenM == "6"}  selected="selected" {/if}>6</option>
							<option value="7"  {if $naikenM == "7"}  selected="selected" {/if}>7</option>
							<option value="8"  {if $naikenM == "8"}  selected="selected" {/if}>8</option>
							<option value="9"  {if $naikenM == "9"}  selected="selected" {/if}>9</option>
							<option value="10" {if $naikenM == "10"} selected="selected" {/if}>10</option>
							<option value="11" {if $naikenM == "11"} selected="selected" {/if}>11</option>
							<option value="12" {if $naikenM == "12"} selected="selected" {/if}>12</option>
						</select>月
						<select name="naikenD" id="naikenD" value="{$naikenD}">
							<option value="0"  {if $naikenD == "" || $naikenD == "0"} selected="selected" {/if}>指定なし</option>
							<option value="1"  {if $naikenD == "1"}  selected="selected" {/if}>1</option>
							<option value="2"  {if $naikenD == "2"}  selected="selected" {/if}>2</option>
							<option value="3"  {if $naikenD == "3"}  selected="selected" {/if}>3</option>
							<option value="4"  {if $naikenD == "4"}  selected="selected" {/if}>4</option>
							<option value="5"  {if $naikenD == "5"}  selected="selected" {/if}>5</option>
							<option value="6"  {if $naikenD == "6"}  selected="selected" {/if}>6</option>
							<option value="7"  {if $naikenD == "7"}  selected="selected" {/if}>7</option>
							<option value="8"  {if $naikenD == "8"}  selected="selected" {/if}>8</option>
							<option value="9"  {if $naikenD == "9"}  selected="selected" {/if}>9</option>
							<option value="10" {if $naikenD == "10"} selected="selected" {/if}>10</option>
							<option value="11" {if $naikenD == "11"} selected="selected" {/if}>11</option>
							<option value="12" {if $naikenD == "12"} selected="selected" {/if}>12</option>
							<option value="13" {if $naikenD == "13"} selected="selected" {/if}>13</option>
							<option value="14" {if $naikenD == "14"} selected="selected" {/if}>14</option>
							<option value="15" {if $naikenD == "15"} selected="selected" {/if}>15</option>
							<option value="16" {if $naikenD == "16"} selected="selected" {/if}>16</option>
							<option value="17" {if $naikenD == "17"} selected="selected" {/if}>17</option>
							<option value="18" {if $naikenD == "18"} selected="selected" {/if}>18</option>
							<option value="19" {if $naikenD == "19"} selected="selected" {/if}>19</option>
							<option value="20" {if $naikenD == "20"} selected="selected" {/if}>20</option>
							<option value="21" {if $naikenD == "21"} selected="selected" {/if}>21</option>
							<option value="22" {if $naikenD == "22"} selected="selected" {/if}>22</option>
							<option value="23" {if $naikenD == "23"} selected="selected" {/if}>23</option>
							<option value="24" {if $naikenD == "24"} selected="selected" {/if}>24</option>
							<option value="25" {if $naikenD == "25"} selected="selected" {/if}>25</option>
							<option value="26" {if $naikenD == "26"} selected="selected" {/if}>26</option>
							<option value="27" {if $naikenD == "27"} selected="selected" {/if}>27</option>
							<option value="28" {if $naikenD == "28"} selected="selected" {/if}>28</option>
							<option value="29" {if $naikenD == "29"} selected="selected" {/if}>29</option>
							<option value="30" {if $naikenD == "30"} selected="selected" {/if}>30</option>
							<option value="31" {if $naikenD == "31"} selected="selected" {/if}>31</option>
						</select>日
						</p>
					</td>
				</tr>
				<tr>
					<th>その他<br /></th>
					<td>
						<p class="inqTxt">その他、ご質問やご希望等ございましたら記入してください。(ご希望の連絡方法や、優先順位、必須条件など)<span>(500文字以内)</span></p>
						<textarea name="Comment" id="Comment" maxlength="500" class="maxlength" cols="60" rows="5" style="IME-MODE: active; width:500px;">{$Comment}</textarea>
						<p class="errTxt" htmlfor="Comment" generated="true" />
					</td>
				</tr>
			</table>
			<p id="privacyTxt">▼必ずお読みください。</p>
			<div id="privacyTitle">
				<p class="txt">個人情報の取り扱いについて</p>
				<p class="link"><a href="http://www.fcapamanshop.com/privacy.html" target="_blank">別ウィンドウで見る</a></p>
			</div>
			<div id="privacyContents">
				<iframe width="100%" scrolling="auto" height="165" frameborder="no" src="/app/html/inquiry/privacy.html" id="privacy"></iframe>
			</div>
			<table class="footTable">
				<tbody>
					<tr>
						<td></td>
						<td class="attTd">SSL暗号化通信を使用してますので、安心して個人情報を送信いただけます。</td>
						<td></td>
						<td class="pointTxt"><a href="javascript:void(0);" onclick="javascript:asrequestEntrySubmit(); return false;" class="links">入力内容を確認して送信</a></td>
						<td>
							<a href="javascript:void(0);">
							<img width="271" height="66" class="rollImg" alt="「個人情報の取り扱いについて」に同意の上今すぐ送信" src="/images/search/detail/btn_send_now.jpg" onclick="javascript:asrequestSendSubmit(); return false;" />
							</a>
						</td>
					</tr>
				</tbody>
			</table>
		<!-- /requestBlock -->
			<div style="text-align:left;">
				<p class="backBtn">
					<a href="/search/houzinrequestsearch" onclick="javascript:asrequestBackToSearch(); return false;"><img src="/images/mypage/common/btn_back.jpg" alt="前画面へ戻る" width="118" height="25" class="rollImg" /></a>
				</p>
			</div>
		</div>
		<!-- InstanceEndEditable -->
	</div>
<!-- 共通タグここから -->
{$hiddenTag}
{* 戻るパラメータ *}
<input type="hidden" name="reRequest" value="1" />
<!-- 共通タグここまで -->
<!-- 共通パラメータここから -->
<input type="hidden" id="condDsp" name="condDsp" value="{$condDsp}" />
<input type="hidden" id="Fax" name="Fax" value="{$Fax}" />
<input type="hidden" id="Name" name="Name" value="{$Name}" />
<input type="hidden" id="Tel" name="Tel" value="{$Tel}" />
<input type="hidden" id="Mail" name="Mail" value="{$Mail}" />
<!--
<input type="hidden" id="Comment" name="Comment" value="{$Comment}" />
<input type="hidden" id="TimeStr" name="TimeStr" value="{$TimeStr}" />
<input type="hidden" id="keiyakutype" name="keiyakutype" value="{$keiyakutype}" />
<input type="hidden" id="UserComName" name="UserComName" value="{$UserComName}" />
<input type="hidden" id="NeedTimeKbn" name="NeedTimeKbn" value="{$NeedTimeKbn}" />
<input type="hidden" id="chushajoDaisu" name="chushajoDaisu" value="{$chushajoDaisu}" />
<input type="hidden" id="nyukyoM" name="nyukyoM" value="{$nyukyoM}" />
<input type="hidden" id="nyukyoD" name="nyukyoD" value="{$nyukyoD}" />
<input type="hidden" id="naikenM" name="naikenM" value="{$naikenM}" />
<input type="hidden" id="naikenD" name="naikenD" value="{$naikenD}" />
-->
<!-- 共通パラメータここまで -->

